Monika M. Safford, MD is Associate Professor of Medicine at the University of Alabama at Birmingham (UAB), where she has built a successful research program in observational and implementation research. This proposed award will permit her to consolidate her effort to continue her mentoring activities while also building her research program in two main areas: 1) in the REasons for Geographic And Racial Differences in Stroke (REGARDS) study, a community-dwelling prospective cohort of 30,239 Black and White individuals; and 2) the Encourage program, which consists of two large extramurally funded group-randomized implementation trials of peer support interventions to improve cardiometabolic parameters in individuals with diabetes. Her main scientific career goals are to better understand underlying reasons for regional and racial disparities in acute CHD outcomes, and to test interventions designed to improve them, with a focus on underserved populations and complex patients, especially those with diabetes. Since focusing her career on cardiometabolic research 13 years ago, she has maintained uninterrupted federal funding totaling over $17 million as Principal Investigator (PI) and has published 159 peer-reviewed reports. Over this time, she has also fostered the academic research careers of 18 clinical fellows and junior clinical faculty, many of whom now have successful independent research careers in patient-oriented research. Her position as Co-PI of the UAB Health Services Research (HSR) Fellowship, which includes 18 Fellows at any time, assures a steady supply of potential mentees. Her Mentoring Aims are to continue to build her teaching and mentoring skills, and to continue to provide outstanding mentorship to mentees and trainees through her research program, leveraging her leadership roles in the UAB HSR Fellowship program and the UAB Center for Outcomes and Effectiveness Research and Education to select promising candidates for training throughout the award period. Her Research Aims are 1) to build on her current work to study the link between processes of care and outcomes for acute coronary syndrome and hear failure, by adding Medicare and Area Resource File data to the REGARDS study data, testing hypotheses generated by her current work; 4 mentees will receive training while conducting these studies with the candidate; 2) In the Encourage program, to conduct a pilot study that takes the next step in her intervention work, developing an intervention guided by Roger's Diffusion of Innovations theory to spread the acceptability of generic medication use via peer supporters, aiming to test the hypothesis that the intervention will improve medication adherence and, in turn, cardiometabolic risk factor levels; 4 mentees will receive training and conduct these studies with the candidate. In the strongly supportive and collaborative environment of UAB, this award will permit Dr. Safford to continue to build her research program as well as capitalizing on her deep commitment to mentoring, now including six career development award recipients, as well as four T-32 fellows.